1912234212 NPI number — SUNSHINE A LITTLE MD

Table of content: (NPI 1912234212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912234212 NPI number — SUNSHINE A LITTLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSHINE A LITTLE MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912234212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3824 NE EVANGELINE THRUWAY
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CARENCRO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70520-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-896-3336
Provider Business Mailing Address Fax Number:
337-896-3376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3824 NE EVANGELINE THRUWAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CARENCRO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70520-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-896-3336
Provider Business Practice Location Address Fax Number:
337-896-3376
Provider Enumeration Date:
11/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LITTLE
Authorized Official First Name:
SUNSHINE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN, OWNER OPERATOR
Authorized Official Telephone Number:
337-896-3336

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  202245 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1505731 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881803138 . This is a "DR'S INDIVIDUAL NPI" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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